Field Letter 19

1. Purpose: To prescribe policies and procedures relating to the operation of State Veterans Homes.

2. Definitions:

a. “State Veterans Home,” means a nursing home or domiciliary approved by the U. S. Department of Veterans Affairs in accordance with 38 CFR Part 51, January 6, 2000, as ameded, which was established by a State primarily for veterans disabled by age, disease or otherwise, who by reason of such disability are incapable of earning a living. The term State Veterans Home includes facilities for skilled nursing care and--or domiciliary care.

b. “Skilled Nursing Care” means the accommodation of convalescents or other persons who are acutely ill and not in need of hospital care, but who require intensive nursing care and related medical services, if such nursing care and medical services are prescribed by, or are performed under the general direction of persons duly licensed to provide such care. The term includes services furnished in skilled nursing care facilities, intermediate care facilities and combined facilities. It does not include domiciliary care.

c. “Domiciliary Care” means providing shelter, food and necessary medical care on an ambulatory self—care basis (this is more than room and board). It assists eligible veterans who are suffering from a disability, disease, or defect of such a degree that incapacitates veterans from earning a living, but who are not in need of hospitalization or nursing care services. It assists in attaining attain physical, mental and social well-being through special rehabilitative programs to restore residents to their highest level of functioning.

d. “War veteran” means any veteran who was discharged under other than dishonorable conditions and who served on active duty in the Armed Forces of the United States, or on active duty in a reserve component of the Armed Forces, including the National Guard, during wartime, or during the period beginning January 31, 1955 and ending on May 7, 1975. Wartime service is defined as:

(1) Spanish-American War: April 21, 1898 – July 4, 1902

(2) Moro Province: April 21, 1898 – July 15, 1903

(3) Mexican Border: May 9, 1916 – April 5, 1917

(4) World War I (Europe): April 6, 1917 – November 11, 1918

(5) World War I (Russia): April 6, 1917 – April 1, 1920

(6) World War II: December 7, 1941 – December 31, 1946

(7) Korea: June 27, 1950 – January 31, 1955

(8) Vietnam: August 5, 1964 – May 7, 1975

(9) Persian Gulf War: August 2, 1990 –

e. “Domicile” means a person’s fixed, permanent and principal home for legal purposes. Registration to vote, claiming homestead exemption and payment of state income and property taxes are factors that could be used in determining domiciliary status.

3. General: The Department of Veterans Service and the Veterans Service Board own and operate two State Veterans Homes for the use and care of war veterans discharged under other than dishonorable conditions. Each State Veterans Home will establish local policies and procedures to implement this field letter. These homes are:

a. Georgia War Veterans Nursing Home, 1101 Fifteenth Street, Augusta, Georgia—a 188 operating bed skilled nursing care facility operated by the Medical College of Georgia under a contractual agreement.

b. Georgia War Veterans Home, Veterans Memorial Drive, Milledgeville, Georgia. This facility includes three buildings with a 375 operating bed capacity used to provide skilled nursing care and one building with a 175 operating bed capacity used to provide domiciliary care. A private contractor operates this home.

4. Conditions for Admission:

a. To be eligible for admission, applicants must meet the requirements outlined below:

(1) Must be domiciled in Georgia and have actually resided in Georgia for at least five (5) years immediately preceding the date of application.

(2) Must be a “war veteran,” as defined in paragraph 2d.

(3) Must be approved as “eligible for care and treatment” by the U. S. Department of Veterans Affairs.

(4) Must not have contagious infectious diseases, behavioral, psychiatric problems or other diagnoses the care and treatment for which may exceed the capability of the homes to provide. Application will be reviewed before a decision will be made on accepting the veteran for admission to the homes. The facilities are unable to care for some cases of these diseases. When the contagious infectious disease, behavioral, psychiatric problems, or other diagnoses the care and treatment for which may exceed the capability of the homes to provide are resolved, under control, or it is determined the home has the capability to provide the care and treatment required, the applicant may be considered for admission based on facility resources.

(5) Must not need to be sustained by line—operated mechanical means (e.g., electrical respirators, external heart pace makers, dialysis machines or other life support apparatuses). The facilities may be unable to care for some of these diseases. When these situations are resolved or it is determined the home has the capability to provide care and treatment required, the applicant may be considered for admission based on facility resources.

(6) Must not be in need of hospital level of services (e.g., surgery, transfusions, intravenous infusion of drugs or fluids).

(7) Must not be participating in medical research programs which have special medical, treatment or transportation requirements.

(8) Must not have criminal charges pending, nor be under restraint or control from any court of law or law enforcement agency.

b. Residents will be required to:

(1) Pay some expenses incurred by regulation (e.g., Medicare or health insurance deductibles and co—pays).

(2) Pay all costs of transportation to and from the home (e.g., medical or other appointments, special outings, etc.), unless specifically provided by the U. S. Department of Veterans Affairs (DVA), or the Georgia Department of Veterans Service.

(3) Abide by the rules and regulations established for resident conduct in the resident handbook and other individual policies, rules and regulation that may from time to time be published by the Georgia Department of Veterans Service or the DVA with the understanding that violations will result in discharge from the home. Operation of a motor vehicle on the premises of the homes is not permitted for residents of the Skilled Nursing Care facilities. Operation of a motor vehicle is permitted for residents of a Domiciliary Care facility, provided the resident does not have a medical diagnosis or is on medication that may limit or impair the resident's ability to operte a motor vehicle.

(4) Accept transfer to other medical facilities (including those operated by the DVA), if medical considerations indicate and pay all costs of transportation, unless provide by the DVA.

(5) Accept dismissal or discharge from the home when medical and administrative review determine such action to be appropriate.

(6) Recognize that each home is operated in full compliance with the U. S. Civil Rights Act without discrimination on the basis of a person’s race, color, religion, national origin, sex, handicap, or age.

c. Medical Eligibility Criteria: All applicants for admission to a State Veterans Home must satisfy medical eligibility requirements established by the State of Georgia and the DVA. Each of the State Veterans Homes will establish local medical eligibility criteria to implement these general criteria.

(1) Skilled Nursing Medical Eligibility Criteria:

(a) Veteran applicants must not be acutely ill and not in need of hospital or domiciliary care, but require skilled nursing care and related medical services prescribed by and under the general direction of persons duly licensed to provide such care.

(b) The Department of Veterans Affairs (DVA) must approve Veterans for skilled care.

(c) A Veteran is not eligible for admission to a skilled nursing facility if he—she has a medical or psychological disorder which, in the opinion of the facility’s Medical Director, is beyond the capacity of the skilled nursing facility to treat, improve, or control.

1 Conditions included in this category are residents who must be sustained by line-operated mechanical means (e.g., electrical respirators, external heart pacers, and etc.) and other diagnoses the care and treatment for which may exceed the capability of the homes to provide.

2 Conditions which may be included in this category are residents who require hemodialysis, large motorized carts for ambulation or residents who are diagnosed with ambulatory dementia—Alzheimer’s with a history of aggressiveness-- combativeness, current alcoholism vs. recovering alcoholic or other medical conditions deemed inappropriate for care by the Medical Director.

(d) Current GWVH domiciliary residents who require admission to one of the skilled nursing facilities must follow normal admission application procedures and submit an updated admission application to the admissions coordinator.

(2) Domiciliary Medical Eligibility Criteria:

(a) Veteran applicants must have a disability, disease, defect or injury producing disability of such degree and probable persistency as will incapacitate the Veteran from earning a living for a prospective period, but not in need of hospitalization or skilled nursing care services. The Veteran must be able to perform activities of daily living such as personal bathing and grooming; self dressing without assistance; using the dining facility without undue aid; self feeding; obtaining medical assistance on an ambulatory basis; have voluntary control over body elimination; participate in treatment and prescribed rehabilitation and restorative activities; and make rational and competent decisions relating to remaining or leaving the Domiciliary.

(b) The Department of Veterans Affairs (DVA) must approve Veterans for domiciliary care.

(c) Veteran applicants approved for admission to the domiciliary must be able to care for themselves and will not meet the criteria as defined above for skilled nursing care. Generally, veteran applicants for the Domiciliary must have a medical problem where the veteran is able to "self-medicate" with little or no supervision by licensed nursing personnel.

(d) A veteran is not eligible for admission to the Domiciliary if he—she has a medical or psychological disorder which in the opinion of the facility’s Medical Director is beyond the capacity of the Domiciliary to treat, improve, or control. These conditions include but are not limited to physical conditions such as alcoholism—substance abuser versus recovering alcoholic or substance abuser, applicants with severe diabetes, cardiovascular or other problems requiring constant monitoring.

5. Application Process:

a. The originating Veterans Service Office (VSO) will complete—provide the following forms for inclusion in the application package of each applicant with the VSO Form 73, Apr 02 [All references to the VSO Form 73 are to this version of the form] serving as the primary application document and the other forms, documents and records serving as attachments thereto. Normally, applications for admission to a State Veterans Home will be originated by a VSO. However, when the application is initiated by another source, e.g., a VAMC, community nursing home, or etc., the completed application will be forwarded to the local or nearest VSO for completion of Part V, of the VSO Form 73. The VSO completing the VSO Form 73 will become the originating VSO for the purpose of that application. (See subparagraph 5.e.)

(1) One (1) copy of APPLICATION FOR ADMISSION TO A GEORGIA WAR VETERANS HOME, VSO Form 73. Detailed instructions for completion of this form are contained on the form. (NOTE: Previous editions of this form are obsolete. Effective 60 days from the date of this Field Letter, obsolete previous editions of this form will no longer be acceptable at the homes. Application packages containing obsolete forms will be returned to the VSO originating the application for correction.)

(a) In PART II, Number 3, indicate by marking the appropriate blocks with a check-mark or “x” to indicate the documentary evidence used by the Georgia Department of Veterans Service Representative to determine the residency requirement has been met by the veteran. Attach a copy(s) of the document(s) to the VSO 73 for submission as part of the application. If the “Other” box(s) is marked, list the document(s) provided by the applicant.

(b) The veteran applicant—designated representative must sign and date PART IV—APPLICANT DECLARATION.

(c) The Georgia Department of Veterans Service Representative must sign and date PART V—VSO REPRESENTATIVE DECLARATION.

(2) Two (2) copies of APPLICATON FOR HEALTH BENEFITS, VA Form 10—10EZ (Apr 98). ~~TWO SIGNATURES REQUIRED~~

(a) The veteran patient must must sign and date the CONSENT TO RELEASE INFORMATION contained at the bottom of Page-1 of the Instruction Sheet to the form, and

(b) The veteran applicant--applicant's representative must sign and date SECTION III--CONSENT TO RELEASE INFORMATION contained at the bottom of Page-2 of the form. If anyone other than the veteran applicant signs this form, a copy of a power of attorney or guardianship paperwork must be attached to the application.

(3) Two (2) copies of STATE HOME PROGRAM APPLICATION FOR VETERAN CARE MEDICAL CERTIFICATION, VA Form 10—10SH; (Jul 98).

(a) The referring physician must include a statement on this form that the applicant is or is not chronically ill and whether or not the applicant has a history of contagious diseases, behavioral, psychiatric disorders--problems, or other diagnoses the care and treatment for which may exceed the capability of the homes to provide.

(b) The referring physician must include a statement on this form, or on a separate sheet, that the applicant has or has not been diagnosed with ambulatory dementia, or ambulatory Alzheimer’s disease.

(c) Applicable signatures of registered nurses—physicians, therapists, social workers and others as necessary must be included on the form or separate sheets.

(4) One (1) copy of APPLICANT ACTIVITIES OF DAILY LIVING SURVEY FORM, VSO Form 106 (Mar 99).

(a) All questions must be answered YES or NO on the form with explanations for all YES answers, or where needed.

b. The applicant will provide a copy of the veteran’s other than dishonorable discharge papers (DD Form 214) with the application.

c. The applicant will provide all current medical information (most recent hospital discharge summary; if no hospitalization, their personal physician’s notes and recommendation for nursing home care).

d. The applicant will provide documentary evidence to support the applicant’s claim of five (5) year residency in Georgia immediately preceding the date of the application (examples include but are not limited to copies of Georgia Income Tax Forms, Georgia Driver License in conjunction with other documents, Voter Registration Card (if dated), school attendance records, or employer affidavit on letterhead, Deed, Homestead Exemption, Record on file in the SDVS Office).

(1) If the document(s) provided support of the five-year residency claim of the applicant, then the VSO Representative will be able to sign Part V of the VSO Form 73. Copies of the document(s), must be provided as part of the application.

(2) If the documents provided do not support the five-year residency claim, then the VSO Representative will not be able to sign Part V of the VSO Form 73 and the VSO and the Home(s) will not process the application.

(1) Veteran requests the VSO (VAMC, community nursing home, etc.) to complete the application packet and provides necessary documents for inclusion with the packet. If someone other than a local VSO initiates the application, the initiator of the application will forward it to the local VSO for a completeness review and certification of Part V, of the VSO Form 73. Then, the VSO submits the completed application to the Admissions Coordinator of the Home(s).

(2) The Home places the veteran's name on an applicant database and begins the applications screening process. The application is screened for admission in accordance with the local policies and procedures of the Home(s). The Homes send locally approved applications to the Augusta VAMC or to the Dublin VAMC for VA certification. When the VA returns the application with approved certification for admission, the Homes add the applicant to the bottom of their waiting list and send a letter to the applicant advising inclusion on the list. Applicants who are approved for admission AND certified by the respective VAMC remain on the waiting list (if required) until a bed is available.

(3) The Homes will maintain the applicant databases and approved waiting lists by date of VA Certification. The databases and associated waiting lists are considered medical records and will be held confidential and not released outside of the Homes. The Executive Directors of the Homes can release an applicant's standing on the list to the applicant or the applicant's designated family member.

(4) Applicants are responsible for updating their medical history (especially should the medical condition change) with the Home(s) while awaiting an available bed. For Georgia application procedures medical information on the VA Form 10--10SH is only valid for 30 days. The Home(s) will notify the applicant of this requirement.

6. Admission Process. Once a Veteran is approved for admission to one of the Homes, the Home will contact the applicant to implement admission procedures. The GWVNH and the GWVH will establish policies and procedures for implementing admissions to the respective Homes. Normally, admissions to the skilled nursing care and domiciliary care facilities will be based on date of approval of the Veteran’s application. GWVH Domiciliary residents who are approved for admission to one of the skilled nursing facilities, or who require emergency admission (application to be completed after-the-fact) to one of the skilled nursing facilities, will be given priority for admission over other applicants.

FIELD LETTER NO. 19